Provider Demographics
NPI:1366487134
Name:WOUND AND HYPERBARIC CENTER LLC
Entity Type:Organization
Organization Name:WOUND AND HYPERBARIC CENTER LLC
Other - Org Name:MEMORIAL WOUND & HYPERBARIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-548-1089
Mailing Address - Street 1:3901 UNIVERSITY BLVD S
Mailing Address - Street 2:STE 221
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4377
Mailing Address - Country:US
Mailing Address - Phone:904-391-1213
Mailing Address - Fax:
Practice Address - Street 1:3901 UNIVERSITY BLVD S
Practice Address - Street 2:STE 221
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4377
Practice Address - Country:US
Practice Address - Phone:904-391-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8125Medicare ID - Type UnspecifiedGROUP NUMBER